Application Form for Non-Degree Programmes 2015/2016

MOSHI CO-OPERATIVE UNIVERSITY (MoCU)
CHUO KIKUU CHA USHIRIKA MOSHI
Sokoine Road,
P.O. Box 474,
Moshi, Tanzania.
Tel:+255 272754401
Fax:+255 272750806
e-mail: info@mocu.ac.tz
Website: www.mocu.ac.tz
DIRECTORATE OF
UNDERGRADUATE STUDIES
P.O. Box 474,
Moshi, Tanzania.
Tel: +255 27 2754401
Fax: +255 27 2750806
E-mail:dus@mocu.ac.tz
APPLICATION FORM FOR ADMISSION TO MoCU UNDERGRADUATE PROGRAMMES FOR 2015/16 ACADEMIC YEAR
One copy of this form, when completed, must be sent to the DEPUTY VICE CHANCELLOR – ACADEMIC, MOSHI CO-OPERATIVE
UNIVERSITY P.O.BOX 474, MOSHI TANZANIA, after paying a non refundable application fee of Tshs 30,000/= through Account No.
01J2036991800 CRDB BANK MOSHI BRANCH. (ACCOUNT NAME: MUCCoBS SAVINGS ACCOUNT) and MUCCoBS DOLLAR
ACCOUNT 02J1038874400 FOR FOREIGN APPLICANTS.
FOR OFFICIAL USE ONLY:
APPLICATION FEE RECEIPT NO:_____________________APPLICATION FORM NO:___________________________
APPLICANT MEETS ENTRY REQUIREMENT FOR___________________________________________ PROGRAMME
1.0
PERSONAL DETAILS
1.1
First Name (in Capital Letters):_____________________________________Middle Name: _______________________
Last Name:______________________________________________________________SEX. (M/F)__________________
(Note: The names entered in this form must be exactly the same as those appearing on your A.C.S.E.E – C.S.E.E.
or other academic certificates).
1.2
Date of Birth (Attach Copy of Birth Certificate):____________________
Place _____________________________
Country___________________________________ Nationality_____________________________
1.3
Permanent Contact Address: __________________________________________________________________________
Tel: Number (Home).________________________ Office______________________ Mobile________________________
E-Mail:_____________________________________
1.4
Name and Address of Sponsor _________________________________________________________________________
__________________________________________________________________________________________________
Tel: Number (Home).________________________ Office______________________ Mobile________________________
Fax: ______________________________
NOTE:
E-Mail:_____________________________
(i)
Deadline for receiving dully filled Application Forms is 26/6/2015.
(ii)
Certificate Programmes Last for One Year; Diploma for Two Years; Degree for Three Years.
(iii)
Certificate in Enterprise Development (CED) –is offered at Kizumbi (Shinyanga) only.
(iv)
Certificate in Management and Accounting and Certificate in Microfinance Management are offered both at
MOSHI and KIZUMBI-SHINYANGA.
(v)
Diploma in Co-operative Management and Accounting and Diploma in Microfinance Management are offered at
MOSHI and KIZUMBI-SHINYANGA.
(vi)
Degree applicants shall have to apply directly to TCU. More information on the mode of application is
available at the TCU website.
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2.0
PROGRAMMES APPLIED FOR:
(Tick the appropriate programme you would like to be enrolled by indicating your first, second and third choice)
Certificate in Management and Accounting (CMA)
Certificate in Microfinance Management (CMF)
Certificate in Accounting and Finance (CAF)
Certificate in Information Technology (CIT)
Certificate in Library and Information Sciences (CLIS)
Certificate in Enterprise Development (CED)
Certificate in Coffee Quality and Trade (CQT)
Diploma in Co-operative Management and Accounting
(DCMA)
Diploma in Enterprise Management (DEMA)
Diploma in Business Information and Communication
Technology (DBICT)
Diploma in Library and Archival Studies (DLAS)
3.0
Diploma in Microfinance Management (DMFM)
SELECTED PLACE OF STUDY
MOSHI MAIN CAMPUS
KIZUMBI CAMPUS-SHINYANGA
4.0
EDUCATION BACKGROUND
4.1 Advanced Certificate of Secondary Education Examination (A.C.S.E.E.) Form Six or Equivalent
Subject
Grade
Date
Index No.
Subject
Grade
Date
Index No.
Division/Class:___________________________ Examining Authority. __________________________________
Examination Centre or School______________________________ Country: ________________________________
4.2 Certificate of Secondary Education Examinations (C.S.E.E.)/National Form Four/or Equivalent. – YOU SHOULD HAVE
PASSED AT LEAST FOUR SUBJECTS WITH A MINIMUM OF D GRADE.
Subject
Grade
Date
Index No.
Subject
Grade
Date
Index No.
Division/Class:___________________________ Examining Authority. ___________________________________
Examination Centre or School______________________________ Country: ________________________________
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4.3 Other Relevant Qualifications (e.g. University Degree, Diploma or Certificate etc.):
Name of University/College/Institute/Examining Board
5.0
Date Obtained
Position Held
Dates
EMPLOYMENT RECORD
Please give details of your employment record in the table below
S/N
6.0
Awards
Name of Employer
ATTACHMENTS
Your application form MUST be submitted together with the following attachments:

Certified Copies of Academic Certificates and Transcripts

Certified Copy of Birth Certificate. Affidavit and Deed Polls ARE NOT ACCEPTED (unless published in the
government gazette)

One Passport Size Photograph recently taken firmly affixed to the application form. The photograph should show your
face for easy identification.

Original Receipt of Application Fee/Bank Pay-in-Slip/Postal Money Order. All these should indicate the name of
the CANDIDATE and name of PROGRAMME applied for.
7.0
DECLARATION
I _________________________________________ (Your full name) do hereby confirm, to the best of my knowledge, that
the information given in this form AND THE ATTACHMENTS ARE correct and complete. I understand that submission of
false documents/ information is a criminal offence AND PUNISHABLE IN a Court of Law.
Signature of Applicant: ______________________
Date______________________
NOTE:
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Place____________________________
INCOMPLETE APPLICATION FORMS SHALL NOT BE PROCESSED.
SUBMISSION OF FALSE INFORMATION OR RECORDS SHALL LEAD TO CRIMINAL PROSECUTION.
RESULT SLIPS SHALL BE ACCEPTED ONLY FOR THOSE WHO COMPLETED THEIR STUDIES IN 2014
FOR FORM FOUR AND 2015 FOR FORM SIX.
ALL APPLICANTS WHO HAVE COMPLETED THEIR SECONDARY EDUCATION IN A FOREIGN COUNTRY
MUST ATTACH A CERTIFICATE OF TRANSLATION OF THEIR GRADES FROM TANZANIA
EXAMINATIONS COUNCIL-DSM
DULLY FILLED FORMS SHOULD BE SUBMITTED TO;
THE DEPUTY VICE CHANCELLOR - ACADEMIC,
MOSHI CO-OPERATIVE UNIVERSITY (MoCU)
P.O. BOX 474,
MOSHI, TANZANIA.
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